PPACA Efforts Intensify as March 31st Enrollment Deadline Nears

According to the latest information, the Administration has determined that enrollment under the PPACA has reached the five million figure, but not the seven million that U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said was the goal in her congressional testimony. With only eight days to go until the PPACA enrollment deadline ends, the Administration has moved to provide various parties additional relief. Individuals who accessed coverage under the exchanges before March 31, but who did not obtain actual coverage before the deadline due to “technical difficulties” would still be considered covered by such date and be exempt from the non-coverage penalty for 2014. The Centers for Medicare and Medicaid Services (CMS) also deferred until the end of April the date when the law’s high-risk pool coverage would end. In addition, CMS issued a 279 page proposed rule providing health insurers participating in the various PPACA health insurance exchanges “premium stabilization” relief. If such insurers incur higher than anticipated administrative costs (due to the spotty rollout of the PPACA), then the insurers can apply for “special circumstances” relief under the law’s risk corridors provision. Relief would be provided by reducing the minimum loss ratio (MLR) from 80% to 78% before an insurer is required to return any cost savings to enrollees. CMS also proposed regulations which clarify the circumstances under which state laws would conflict with federal law, thus better enabling consumers to be informed of their choices and insurers of their responsibilities to assist their policyholders. CMS also clarified the circumstances under which the PPACA’s reinsurance program would aid insurers and third-party administrators, particularly when federal funds are strained as a result of the extension of the “if you like your plan, you can keep it” rule through plan years beginning before October 16, 2016. Of note, in connection with the delay of the employer mandate, the U.S. District Court for the Eastern District of Wisconsin dismissed a lawsuit by a physician’s group which contested the ruling. In addition, the U.S. Supreme Court will hear arguments as to whether private employers can avoid the law’s contraceptive benefits mandate if they have religious objections.

CMS Asks Congress for New Authority on Appeals

The CMS Medicare/Medicaid Coordination Office has asked Congress for authority under new legislation that would: allow the agency to merge the appeals process under Medicare and Medicaid; ensure retroactive prescription drug coverage for dual-eligibles by making an existing demonstration project a permanent one; and extend the Program for All-Inclusive Care for the Elderly (PACE) to individuals between 21 and 55.

Hospice Pilot Program Announced

CMS announced that, under the PPACA’s Medicare Care Choices Model concurrent care demonstration, the agency will allow Medicare hospice patients to have access to palliative and restorative care. In related news, CMS said that it will not, at this time, initiate an independent review of cases in which a hospice and a Medicare Part D drug sponsor disagree on who has financial responsibility for a drug given to a hospice patient.

FDA Medical Device Classification Proposal

The FDA issued a proposed rule under which the agency would revise its device reclassification process to conform to the Food and Drug Administration Safety and Innovation Act (FDASIA). In another action, the agency proposed to update the definitions of class I (low risk) , class II (medium risk) and class III (high risk) devices to better reflect the level of risk associated with the device and the level of regulation needed to provide a “reasonable assurance of safety and effectiveness.”

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